Provider Demographics
NPI:1861474512
Name:PETRUNIK, JOANNE E (OT CHT)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:E
Last Name:PETRUNIK
Suffix:
Gender:F
Credentials:OT CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 ROUTE 46
Mailing Address - Street 2:BUILDING #3
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4909
Mailing Address - Country:US
Mailing Address - Phone:973-334-4321
Mailing Address - Fax:973-334-1095
Practice Address - Street 1:111 MADISON AVE STE 303
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7359
Practice Address - Country:US
Practice Address - Phone:973-267-0991
Practice Address - Fax:973-267-0930
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00297400225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067850NXZMedicare PIN